Medication-related osteonecrosis (MRONJ) of the mandible and maxilla.

In 2003, Marx reported the first case of osteonecrosis of the jaw in 36 cases related to zoledronic acid or pamidronate. Painful bone exposure in the mandible or maxilla unresponsive to medical or surgical management was observed. In 2014, the American Association of Oral and Maxillofacial Surgeons proposed the term 'medication-related osteonecrosis of the jaw' (MRONJ). However, a non-exposed variant may also occur. MRONJ can lead to debilitating clinical sequelae with limited treatment options. We present the case of a 73-year-old woman with metastatic breast cancer and MRONJ of her mandible and maxilla following treatment with intravenous zoledronic acid and denosumab. Six months following dental extractions, she was referred to the Department of Oral and Maxillofacial Surgery for assessment of extensive necrosis of her maxilla and mandible. Extraoral draining sinuses were observed. A CT mandible showed cortical destruction with an ill-defined mixed sclerotic-lucent pattern in keeping with osteonecrosis. Due to her metastatic breast cancer, the extent of her necrosis and poor performance status, free flap reconstruction of her mandible was ruled out. She was treated conservatively.

Tumour depth of invasion of pT1 squamous cell carcinoma of the oral tongue and risk of pathologically detected neck metastases.

BACKGROUND: Tumour depth of invasion (TDI) is considered a predictor of pathologically detected neck metastases (PDNM) for squamous cell carcinoma (SCC), but different investigators have arrived at different cut-off of TDI. However, the relationship between TDI of pT1 SCC of the oral tongue and PDNM remains unknown. METHODS: Data was collected for patients with pT1SCC of the oral tongue. TDI, neurovascular invasion, pattern of invasion and presence of PDNM were recorded. The relationship between data was studied using logistic regression and ROC methods. RESULTS: With all other factors held constant, data showed that the odds ratio for each millimetre increase in TDI and risk of PDNM was 1.09 (95% CI: 0.95 - 1.25, p = 0.234), which was insignificant. CONCLUSION: TDI is not accurate and cannot be used as predictor of PDNM in patients with pT1 SCC of the tongue. Further, true TDI can only be assessed on resection specimens. This article is protected by copyright. All rights reserved.